Differential Diagnosis for Toe Pain
The patient presents with persistent toe pain, redness, and swelling despite initial treatment for gout. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Gout: Although the patient was already treated for gout, it remains a likely diagnosis given the symptoms of toe pain, redness, and swelling. The initial treatment may not have been adequate, or the diagnosis may have been correct but the treatment failed.
Other Likely diagnoses
- Cellulitis: A bacterial infection of the skin and soft tissues, which could explain the redness, swelling, and pain in the toe.
- Osteoarthritis: Wear and tear on the joints can cause pain and swelling, especially if the patient has a history of arthritis.
- Sesamoiditis: Inflammation of the sesamoid bones under the first metatarsal bone, which could cause pain and swelling in the toe.
- Bursitis: Inflammation of the fluid-filled sacs that cushion joints and reduce friction, which could cause pain and swelling.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis: A bone infection that can cause pain, redness, and swelling, and can lead to serious complications if left untreated.
- Septic arthritis: A joint infection that can cause pain, redness, and swelling, and can lead to serious complications if left untreated.
- Deep vein thrombosis (DVT): A blood clot in the deep veins, which can cause pain and swelling in the leg and can lead to pulmonary embolism if left untreated.
Rare diagnoses
- Rheumatoid arthritis: An autoimmune disorder that can cause pain and swelling in the joints, including the toes.
- Psoriatic arthritis: A type of arthritis that occurs in people with psoriasis, which can cause pain and swelling in the joints, including the toes.
- Neuroma: A growth of nerve tissue that can cause pain and swelling in the toes.
- Inflammatory bowel disease (IBD)-related arthritis: Some patients with IBD, such as Crohn's disease or ulcerative colitis, can develop arthritis that affects the joints, including the toes.